A Scoring System to Predict the Risk of Postoperative Complications After Laparoscopic Gastrectomy for Gastric Cancer Based on a Large-Scale Retrospective Study

Purpose The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival, morbidity, and mortality retrospectively. Patients and Methods The study group comprised 2,976 patients who were treated with curative intent either by laparoscopic gastrectomy (1,477 patients) or open gastrectomy (1,499 patients) between April 1998 and December 2005. The long-term 5-year actual survival analysis in case-control and case-matched population was conducted using the Kaplan-Meier method. The morbidity and mortality and learning curves were evaluated. Results In the case-control study, the overall survival, disease-specific survival, and recurrence-free survival (median follow-up period, 70.8 months) were not statistically different at each cancer stage with the exception of an increased overall survival rate for patients with stage IA cancer treated via laparoscopy (laparoscopic group; 95.3%, open group: 90.3%; P < .001). After matching using a propensity scoring system, the overall survival, disease-specific survival, and recurrence-free survival rates were not statistically different at each stage. The morbidity of the case-matched group was 15.1% in the open group and 12.5% in the laparoscopic group, which also had no statistical significance (P = .184). The mortality rate was also not statistically significant (0.3% in the open group and 0.5% in the laparoscopic group; P = 1.000). The mean learning curve was 42. Conclusion The long-term oncologic outcomes of laparoscopic gastrectomy for patients with gastric cancer were comparable to those of open gastrectomy in a large-scale, multicenter, retrospective clinical study.

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Clinical Evaluation of Laparoscopic Gastrectomy for Gastric Cancer in the Elderly Patients Using POSSUM and E-PASS Scoring System

Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) ◽

10.4030/jjcs.41.559 ◽

2016 ◽

Vol 41 (4) ◽

pp. 559-566

Author(s):

Takeshi Matsutani ◽

Itsuro Fujita ◽

Yoshikazu Kanazawa ◽

Nobutoshi Hagiwara ◽

Tsutomu Nomura ◽

...

Keyword(s):

Gastric Cancer ◽

Elderly Patients ◽

Clinical Evaluation ◽

Laparoscopic Gastrectomy ◽

Scoring System ◽

The Elderly

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Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA): A Multicenter Randomized Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.20.01540 ◽

2021 ◽

pp. JCO.20.01540

Author(s):

Arjen van der Veen ◽

Hylke J. F. Brenkman ◽

Maarten F. J. Seesing ◽

Leonie Haverkamp ◽

Misha D. P. Luyer ◽

...

Keyword(s):

Gastric Cancer ◽

Postoperative Complications ◽

Hospital Stay ◽

Advanced Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Operating Time ◽

Laparoscopic Group ◽

Open Gastrectomy ◽

R0 Resection ◽

Lymph Node Yield

BACKGROUND The oncological efficacy and safety of laparoscopic gastrectomy are under debate for the Western population with predominantly advanced gastric cancer undergoing multimodality treatment. METHODS In 10 experienced upper GI centers in the Netherlands, patients with resectable (cT1-4aN0-3bM0) gastric adenocarcinoma were randomly assigned to either laparoscopic or open gastrectomy. No masking was performed. The primary outcome was hospital stay. Analyses were performed by intention to treat. It was hypothesized that laparoscopic gastrectomy leads to shorter hospital stay, less postoperative complications, and equal oncological outcomes. RESULTS Between 2015 and 2018, a total of 227 patients were randomly assigned to laparoscopic (n = 115) or open gastrectomy (n = 112). Preoperative chemotherapy was administered to 77 patients (67%) in the laparoscopic group and 87 patients (78%) in the open group. Median hospital stay was 7 days (interquartile range, 5-9) in both groups ( P = .34). Median blood loss was less in the laparoscopic group (150 v 300 mL, P < .001), whereas mean operating time was longer (216 v 182 minutes, P < .001). Both groups did not differ regarding postoperative complications (44% v 42%, P = .91), in-hospital mortality (4% v 7%, P = .40), 30-day readmission rate (9.6% v 9.1%, P = 1.00), R0 resection rate (95% v 95%, P = 1.00), median lymph node yield (29 v 29 nodes, P = .49), 1-year overall survival (76% v 78%, P = .74), and global health-related quality of life up to 1 year postoperatively (mean differences between + 1.5 and + 3.6 on a 1-100 scale; 95% CIs include zero). CONCLUSION Laparoscopic gastrectomy did not lead to a shorter hospital stay in this Western multicenter randomized trial of patients with predominantly advanced gastric cancer. Postoperative complications and oncological efficacy did not differ between laparoscopic gastrectomy and open gastrectomy.

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